(1238) Ascertaining Design Needs for a Telecritical Care Consult Service: An Intervention Mapping Approach

Introduction: Patients with borderline acuity frequently transfer from hospital floors to ICUs without well-defined ICU indications. Key drivers of transfers include varying levels of clinician comfort and limited floor resources for borderline patient care. We previously identified tele-critical care consultation (TC3) as an option to support floor clinicians. This study established a stakeholder-informed TC3 workflow.

Methods: We assembled a 12-member stakeholder advisory board including MDs, RNs, and advanced practice providers from the hospital medicine floor, ICU, tele-critical care, and rapid response team. Across 4 two-hour sessions, we completed a multi-step intervention mapping (IM) process: objective development, intervention design, intervention development, implementation planning, and evaluation planning. We followed a thematic analysis to inform findings at each step.

Results: TC3 objectives included (1) improving floor MD/RN confidence with treating borderline patients, (2) reducing workload for floor MDs/RNs, and (3) streamlining required ICU transfers.

Intervention design elements related to objective 1: TC3 MD support for diagnosis and care plan creation and TC3 RN support for questions about care plan execution; objective 2: patient monitoring using audio-video and vital sign feeds, documentation support by TC3 RNs, optional order entry by TC3 MDs, and as-needed mobilization of rapid response RNs for hands-on help; and objective 3: timely, as-needed ICU bed procurement by TC3 MDs.

Intervention development resulted in a workflow with an initial conversation between the floor and TC3 teams, a time-limited period of TC3-supported care, and a wrap-up discussion at end of consultation.

Implementation planning entailed creation of educational and supporting materials for increasing awareness of TC3 roll-out and implementation.

Evaluation planning included review and finalization of feasibility outcomes (number of consults per week, time spent), clinician satisfaction, and patient outcomes (e.g., ultimate patient disposition, length of stay).

Conclusions: Using an IM approach, we established a TC3 workflow acceptable to leaders and staff members representing the various clinical areas. Ongoing work involves pilot implementation of the TC3 service on a single hospital floor.